TREATMENT HOME STABILIZATION SERVICES PROVIDER COMMUNICATION/PROCESS CHILDREN’S SYSTEM OF CARE 12/13/12 Children’s System of Care is pleased to announce a pilot that will enable treatment home providers to request stabilization services for a child/youth/young adult who is at risk of jeopardizing his or her current placement due to pre‐crisis situations. Our goal was to develop a resource that supports treatment home agencies in the management of escalating behaviors so that a child/youth/young adult may stabilize, thus avoiding premature discharge and admission to a more restrictive environment. Scope of Stabilization Services This pilot officially deployed on 11/13/12. Stabilization services are only applicable to CSOC‐ contracted treatment home provider agencies. These services must not supplant treatment home agency contractual obligations (i.e. services provided through the contracted per diem rate). Available services will be similar to MRSS stabilization, and will include the following: • IIC: 3 hours max per week • BA: 5 hours max per week Services may be requested for a maximum duration of eight‐weeks, with a possible four‐week extension if clinically justified. Distribution of units will be at the discretion of the treatment team. Information regarding BA/IIC service delivery is located on the PerformCare website at http://www.performcarenj.org/provider/clinical‐criteria.aspx. Collaboration with CSOC Case Management (YCM, UCM, CMO) prior to requesting stabilization services is mandatory in order to assure that all team members are aware of this service request. If a child/youth/young adult is not open with a CSOC Case Management Entity (CME) at the time of the stabilization service referral, PerformCare will assign the child/youth to CMO or UCM for additional support services. Upon implementation, providers may utilize existing active authorizations for BA/IIC services. However, subsequent requests must follow this new process. Stabilization service requests via Joint Care Review (JCR) will no longer be accepted. Access to IIC/BA Providers Treatment home providers may utilize BA/IIC providers from their respective agencies or select a provider outside their agencies. Treatment home providers who do not have internal BA/IIC resources may choose from a list of approved BA/IIC providers on CYBER. Providers may access this list by completing the following steps: 1) On Welcome Page, click the Provider Details tab; 2) Click the DCBHS Providers tab; 3) Click on Program; a dropdown list of service lines will appear; select BA/IIC: 4) A complete list of approved BA/IIC providers will appear; user may sort by clicking on column headers. 1
Stabilization Service Request Process 1. Treatment Team Meeting is held with all involved parties and all must agree that stabilization services are required due to escalating behavior that cannot be managed with current level of contracted services; 2. Treatment home provider completes an updated Strength and Needs Assessment within 2 business days and submits to PerformCare; 3. Treatment Home Provider enters a Treatment Home Stabilization Progress Note in the child/youth’s CYBER record which must contain the following information: 1) Confirmation that collaboration occurred with case management (via in‐person or phone contact) and that all parties are aware of the need for stabilization service request; 2) Confirmation that Strength and Needs Assessment (SNA) was completed and submitted to PerformCare; 3) Specify the ID# of the SNA for reference; 4) Brief clinical description of behaviors that are jeopardizing placement and justification for stabilization services; 5) Description of how service will lead to a sustainable plan moving forward; 4. Treatment Home Provider e‐mails PerformCare (servicedesk@performcarenj.org) using THSS as subject line and will formally request service. This e‐mail must include the following information: 1) Youth CYBER ID; 2) Treatment Home Provider Name/Medicaid ID; 3) Provider Name/Medicaid ID of the BA/IIC being requested; 5. This request is ticketed by the Service Desk and is assigned to a Clinical Care Coordinator for review and authorization; Clinical Care Coordinator will render a decision within one (1) business day of receipt; 6. If clinical justification is insufficient or there is missing information, the Clinical Care Coordinator will indicate what information is needed in the CSA progress note type. The treatment home provider may then submit the additional information and send a new e‐mail to the Service Desk initiating the request again; 7. Once the stabilization request is reviewed and approved, PerformCare will generate an authorization in CYBER and will document the authorization confirmation in the youth’s progress note; 8. Upon receiving authorization, the treatment home provider is responsible for calling the chosen IIC/BA provider in order to confirm referral and initiate services. The treatment home provider shall also enter a progress note in the youth’s record confirming that contact has been made; 2
9. Upon completion of the stabilization service, the treatment home provider shall enter a special progress note type called Treatment Home Stabilization Summary, which should provide documentation of the service delivery outcome and its effectiveness in maintaining the youth’s placement. Service Extension Request Providers may request a four‐week extension of services, which will require the provider to follow the initial request process (as described above). Stabilization services may be requested more than once throughout the duration of a youth’s treatment home placement. Future Process Upon determining the effectiveness of this piloted model, CSOC will develop and deploy a clinical document within CYBER which would enable treatment home providers to electronically submit service requests directly to PerformCare. Additional information is forthcoming. A complete training guide on this Treatment Home Stabilization Service Process is located on the PerformCare Website (www.performcarenj.org) under Providers/Training. 3